Women to have children after cervical cancer

An alternative form of surgery for treating cervical cancer could enable hundreds of women with the disease to be rid of the disease without giving up hope of having a family.

An alternative form of surgery for treating cervical cancer could enable hundreds of women with the disease to be rid of the disease without giving up hope of having a family.

The most common treatment for cervical cancer – radical hysterectomy – removes the cervix and womb and leaves the patient infertile. But now cancer specialists are hopeful that, with early detection, the disease can be treated by less drastic surgery which leaves the womb still intact and maintains fertility.

Professor John Shepherd, a consultant gynaecological oncologist at St Bartholomew's hospital in London, has developed the treatment during the past seven years. He said it could represent an even greater breakthrough in the treatment of women's cancers than the realisation 25 years ago that breast cancer did not always need to be treated by radical mastectomy. "I think this is going to have a greater impact potentially in terms of infertility implications," he said.

The operation, a trachelectomy, involves removing the cervix and a small amount of surrounding tissue and attaching the uterus directly to the vaginal canal. Six months after the operation, the patient can begin trying to conceive naturally and, if successful, gives birth by caesarean section, although the removal of the cervix can result in premature labour.

Professor Shepherd, whose findings are published in next month's British Journal of Obstetrics and Gynaecology, has been developing the procedure with colleagues in France and Canada. He estimates that between four and five hundred women out of the 3,000 who are diagnosed with cervical cancer in the UK each year could benefit from the treatment. In 1999, it was the second most common cancer in women under 35, claiming 1,100 lives.

So far, the treatment has only been given to women who are of child-bearing age and who have not yet had children but want to, and where the cancer is in its early stages with no sign of infection detected outside the cervix itself.

Eighty women, ranging in age from 24 to 45, have undergone the procedure. Out of 22 pregnancies, 12 women have gone on to give birth and a 13th is expecting a baby in two months' time. In two cases, the cancer has returned, although Professor Shepherd stresses this is lower than the expected recurrence rate.

The procedure itself is nothing new. Hippocrates performed one in 400BC and it was briefly revived as a treatment for cervical cancer in the 1940s in Europe, but fell into disrepute because of its high failure rate.

However, advances in pathological knowledge and the success of the national cervical cancer-screening programme have made it viable again, Professor Shepherd says.

"It is not a straightforward operation – it is much more difficult than doing a radical hysterectomy and there are risks and possible complications," he said. "The major criteria is that the patient should have a realistic chance and an absolute desire for pregnancy."

"We are very pleased by the pregnancies. Even my fertility colleagues couldn't believe it. We have had a much larger proportion of women getting pregnant and holding pregnancies than we would have expected."

Professor Shepherd said that the operation should only be carried out as part of a research programme until it is more fully developed,